|
PR EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 67840
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$410.49 |
| Rate for Payer: Aetna Commercial |
$194.29
|
| Rate for Payer: Aetna Medicare |
$150.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.79
|
| Rate for Payer: BCBS Complete |
$104.44
|
| Rate for Payer: BCBS MAPPO |
$144.99
|
| Rate for Payer: BCBS Trust/PPO |
$337.06
|
| Rate for Payer: BCN Commercial |
$410.49
|
| Rate for Payer: BCN Medicare Advantage |
$144.99
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cofinity Commercial |
$194.29
|
| Rate for Payer: Cofinity Commercial |
$208.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.24
|
| Rate for Payer: Meridian Medicaid |
$104.44
|
| Rate for Payer: Nomi Health Commercial |
$173.99
|
| Rate for Payer: PACE SWMI |
$144.99
|
| Rate for Payer: PHP Commercial |
$202.99
|
| Rate for Payer: PHP Medicare Advantage |
$144.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.15
|
| Rate for Payer: Priority Health Medicare |
$144.99
|
| Rate for Payer: Priority Health Narrow Network |
$273.15
|
| Rate for Payer: Priority Health SBD |
$273.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.99
|
| Rate for Payer: UHC Medicare Advantage |
$144.99
|
| Rate for Payer: UHCCP Medicaid |
$99.47
|
| Rate for Payer: UMR Bronson Commercial |
$209.30
|
|
|
PR EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 40816
|
| Min. Negotiated Rate |
$196.60 |
| Max. Negotiated Rate |
$794.95 |
| Rate for Payer: Aetna Commercial |
$384.57
|
| Rate for Payer: Aetna Medicare |
$298.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.27
|
| Rate for Payer: BCBS Complete |
$206.43
|
| Rate for Payer: BCBS MAPPO |
$286.99
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$590.81
|
| Rate for Payer: BCN Medicare Advantage |
$286.99
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Cofinity Commercial |
$384.57
|
| Rate for Payer: Cofinity Commercial |
$413.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.34
|
| Rate for Payer: Meridian Medicaid |
$206.43
|
| Rate for Payer: Nomi Health Commercial |
$344.39
|
| Rate for Payer: PACE SWMI |
$286.99
|
| Rate for Payer: PHP Commercial |
$401.79
|
| Rate for Payer: PHP Medicare Advantage |
$286.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$547.08
|
| Rate for Payer: Priority Health Medicare |
$286.99
|
| Rate for Payer: Priority Health Narrow Network |
$547.08
|
| Rate for Payer: Priority Health SBD |
$547.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.99
|
| Rate for Payer: UHC Medicare Advantage |
$286.99
|
| Rate for Payer: UHCCP Medicaid |
$196.60
|
| Rate for Payer: UMR Bronson Commercial |
$562.58
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 40814
|
| Min. Negotiated Rate |
$183.82 |
| Max. Negotiated Rate |
$684.68 |
| Rate for Payer: Aetna Commercial |
$358.77
|
| Rate for Payer: Aetna Medicare |
$278.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.55
|
| Rate for Payer: BCBS Complete |
$193.01
|
| Rate for Payer: BCBS MAPPO |
$267.74
|
| Rate for Payer: BCBS Trust/PPO |
$684.68
|
| Rate for Payer: BCN Commercial |
$548.78
|
| Rate for Payer: BCN Medicare Advantage |
$267.74
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$358.77
|
| Rate for Payer: Cofinity Commercial |
$385.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.13
|
| Rate for Payer: Meridian Medicaid |
$193.01
|
| Rate for Payer: Nomi Health Commercial |
$321.29
|
| Rate for Payer: PACE SWMI |
$267.74
|
| Rate for Payer: PHP Commercial |
$374.84
|
| Rate for Payer: PHP Medicare Advantage |
$267.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.30
|
| Rate for Payer: Priority Health Medicare |
$267.74
|
| Rate for Payer: Priority Health Narrow Network |
$508.30
|
| Rate for Payer: Priority Health SBD |
$508.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.74
|
| Rate for Payer: UHC Medicare Advantage |
$267.74
|
| Rate for Payer: UHCCP Medicaid |
$183.82
|
| Rate for Payer: UMR Bronson Commercial |
$312.34
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 40812
|
| Min. Negotiated Rate |
$117.36 |
| Max. Negotiated Rate |
$465.43 |
| Rate for Payer: Aetna Commercial |
$229.56
|
| Rate for Payer: Aetna Medicare |
$178.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.69
|
| Rate for Payer: BCBS Complete |
$123.23
|
| Rate for Payer: BCBS MAPPO |
$171.31
|
| Rate for Payer: BCBS Trust/PPO |
$465.43
|
| Rate for Payer: BCN Commercial |
$332.58
|
| Rate for Payer: BCN Medicare Advantage |
$171.31
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Cofinity Commercial |
$246.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.88
|
| Rate for Payer: Meridian Medicaid |
$123.23
|
| Rate for Payer: Nomi Health Commercial |
$205.57
|
| Rate for Payer: PACE SWMI |
$171.31
|
| Rate for Payer: PHP Commercial |
$239.83
|
| Rate for Payer: PHP Medicare Advantage |
$171.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.94
|
| Rate for Payer: Priority Health Medicare |
$171.31
|
| Rate for Payer: Priority Health Narrow Network |
$326.94
|
| Rate for Payer: Priority Health SBD |
$326.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.31
|
| Rate for Payer: UHC Medicare Advantage |
$171.31
|
| Rate for Payer: UHCCP Medicaid |
$117.36
|
| Rate for Payer: UMR Bronson Commercial |
$264.50
|
|
|
PR EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 42107
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$666.56 |
| Rate for Payer: Aetna Commercial |
$413.90
|
| Rate for Payer: Aetna Medicare |
$321.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.79
|
| Rate for Payer: BCBS Complete |
$221.19
|
| Rate for Payer: BCBS MAPPO |
$308.88
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$666.56
|
| Rate for Payer: BCN Medicare Advantage |
$308.88
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$413.90
|
| Rate for Payer: Cofinity Commercial |
$444.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.32
|
| Rate for Payer: Meridian Medicaid |
$221.19
|
| Rate for Payer: Nomi Health Commercial |
$370.66
|
| Rate for Payer: PACE SWMI |
$308.88
|
| Rate for Payer: PHP Commercial |
$432.43
|
| Rate for Payer: PHP Medicare Advantage |
$308.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$581.08
|
| Rate for Payer: Priority Health Medicare |
$308.88
|
| Rate for Payer: Priority Health Narrow Network |
$581.08
|
| Rate for Payer: Priority Health SBD |
$581.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.88
|
| Rate for Payer: UHC Medicare Advantage |
$308.88
|
| Rate for Payer: UHCCP Medicaid |
$210.66
|
| Rate for Payer: UMR Bronson Commercial |
$414.92
|
|
|
PR EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$87.33 |
| Max. Negotiated Rate |
$1,644.60 |
| Rate for Payer: Aetna Commercial |
$170.92
|
| Rate for Payer: Aetna Medicare |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.67
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$127.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.60
|
| Rate for Payer: BCN Commercial |
$320.57
|
| Rate for Payer: BCN Medicare Advantage |
$127.55
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cofinity Commercial |
$170.92
|
| Rate for Payer: Cofinity Commercial |
$183.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.93
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Nomi Health Commercial |
$153.06
|
| Rate for Payer: PACE SWMI |
$127.55
|
| Rate for Payer: PHP Commercial |
$178.57
|
| Rate for Payer: PHP Medicare Advantage |
$127.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.40
|
| Rate for Payer: Priority Health Medicare |
$127.55
|
| Rate for Payer: Priority Health Narrow Network |
$243.40
|
| Rate for Payer: Priority Health SBD |
$243.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.55
|
| Rate for Payer: UHC Medicare Advantage |
$127.55
|
| Rate for Payer: UHCCP Medicaid |
$87.33
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
|
|
PR EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 42106
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$1,938.86 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna Medicare |
$158.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.34
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCBS MAPPO |
$152.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.86
|
| Rate for Payer: BCN Commercial |
$374.33
|
| Rate for Payer: BCN Medicare Advantage |
$152.32
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cofinity Commercial |
$204.11
|
| Rate for Payer: Cofinity Commercial |
$219.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.94
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Nomi Health Commercial |
$182.78
|
| Rate for Payer: PACE SWMI |
$152.32
|
| Rate for Payer: PHP Commercial |
$213.25
|
| Rate for Payer: PHP Medicare Advantage |
$152.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.16
|
| Rate for Payer: Priority Health Medicare |
$152.32
|
| Rate for Payer: Priority Health Narrow Network |
$288.16
|
| Rate for Payer: Priority Health SBD |
$288.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.32
|
| Rate for Payer: UHC Medicare Advantage |
$152.32
|
| Rate for Payer: UHCCP Medicaid |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$232.76
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
55520
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$447.35 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna American Axle |
$825.50
|
| Rate for Payer: Aetna Commercial |
$1,079.50
|
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,839.21
|
| Rate for Payer: BCN Commercial |
$1,839.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$1,092.20
|
| Rate for Payer: Cofinity Commercial |
$889.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$889.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$1,143.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$889.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$952.50
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,079.50
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$1,079.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Priority Health SBD |
$800.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.08
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$447.35
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: UMR Bronson Commercial |
$469.90
|
| Rate for Payer: VA VA |
$3,379.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$952.50
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
55520
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$558.80 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Aetna American Axle |
$825.50
|
| Rate for Payer: Aetna Commercial |
$1,079.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.50
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$1,092.20
|
| Rate for Payer: Cofinity Commercial |
$889.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$889.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.00
|
| Rate for Payer: Healthscope Commercial |
$1,143.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$889.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$952.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,079.50
|
| Rate for Payer: PHP Commercial |
$1,079.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health SBD |
$800.10
|
| Rate for Payer: UMR Bronson Commercial |
$558.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$952.50
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 55520
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$2,718.10 |
| Rate for Payer: Aetna Commercial |
$596.78
|
| Rate for Payer: Aetna Medicare |
$463.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.32
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS MAPPO |
$445.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,718.10
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: BCN Medicare Advantage |
$445.36
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$596.78
|
| Rate for Payer: Cofinity Commercial |
$641.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.63
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$534.43
|
| Rate for Payer: PACE SWMI |
$445.36
|
| Rate for Payer: PHP Commercial |
$623.50
|
| Rate for Payer: PHP Medicare Advantage |
$445.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.25
|
| Rate for Payer: Priority Health Medicare |
$445.36
|
| Rate for Payer: Priority Health Narrow Network |
$739.25
|
| Rate for Payer: Priority Health SBD |
$739.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.36
|
| Rate for Payer: UHC Medicare Advantage |
$445.36
|
| Rate for Payer: UHCCP Medicaid |
$298.20
|
| Rate for Payer: UMR Bronson Commercial |
$584.20
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$2,718.10 |
| Rate for Payer: Aetna Commercial |
$596.78
|
| Rate for Payer: Aetna Medicare |
$463.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.32
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS MAPPO |
$445.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,718.10
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: BCN Medicare Advantage |
$445.36
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$641.32
|
| Rate for Payer: Cofinity Commercial |
$596.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.63
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$534.43
|
| Rate for Payer: PACE SWMI |
$445.36
|
| Rate for Payer: PHP Commercial |
$623.50
|
| Rate for Payer: PHP Medicare Advantage |
$445.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.25
|
| Rate for Payer: Priority Health Medicare |
$445.36
|
| Rate for Payer: Priority Health Narrow Network |
$739.25
|
| Rate for Payer: Priority Health SBD |
$739.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.36
|
| Rate for Payer: UHC Medicare Advantage |
$445.36
|
| Rate for Payer: UHCCP Medicaid |
$298.20
|
| Rate for Payer: UMR Bronson Commercial |
$584.20
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$912.85 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.40
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Commercial |
$428.16
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.63
|
| Rate for Payer: Priority Health Medicare |
$305.83
|
| Rate for Payer: Priority Health Narrow Network |
$495.63
|
| Rate for Payer: Priority Health SBD |
$495.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$464.64 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Aetna American Axle |
$686.40
|
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.40
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$739.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$792.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health SBD |
$665.28
|
| Rate for Payer: UMR Bronson Commercial |
$464.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$792.00
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna American Axle |
$686.40
|
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.73
|
| Rate for Payer: BCN Commercial |
$1,737.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$739.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$792.00
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$665.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.46
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$306.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: UMR Bronson Commercial |
$390.72
|
| Rate for Payer: VA VA |
$1,568.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$792.00
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$912.85 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.40
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Commercial |
$428.16
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.63
|
| Rate for Payer: Priority Health Medicare |
$305.83
|
| Rate for Payer: Priority Health Narrow Network |
$495.63
|
| Rate for Payer: Priority Health SBD |
$495.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$201.29 |
| Max. Negotiated Rate |
$676.82 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.84
|
| Rate for Payer: BCBS Complete |
$211.35
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Meridian Medicaid |
$211.35
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Commercial |
$414.01
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.29
|
| Rate for Payer: Priority Health Medicare |
$295.72
|
| Rate for Payer: Priority Health Narrow Network |
$476.29
|
| Rate for Payer: Priority Health SBD |
$476.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
| Rate for Payer: UHCCP Medicaid |
$201.29
|
| Rate for Payer: UMR Bronson Commercial |
$407.56
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$296.50 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna American Axle |
$575.90
|
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Cofinity Commercial |
$620.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.50
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$558.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.15
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$296.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: UMR Bronson Commercial |
$327.82
|
| Rate for Payer: VA VA |
$1,568.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.50
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$201.29 |
| Max. Negotiated Rate |
$676.82 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.84
|
| Rate for Payer: BCBS Complete |
$211.35
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Meridian Medicaid |
$211.35
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Commercial |
$414.01
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.29
|
| Rate for Payer: Priority Health Medicare |
$295.72
|
| Rate for Payer: Priority Health Narrow Network |
$476.29
|
| Rate for Payer: Priority Health SBD |
$476.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
| Rate for Payer: UHCCP Medicaid |
$201.29
|
| Rate for Payer: UMR Bronson Commercial |
$407.56
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$389.84 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Aetna American Axle |
$575.90
|
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.90
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$620.20
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health SBD |
$558.18
|
| Rate for Payer: UMR Bronson Commercial |
$389.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.50
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: Aetna Commercial |
$348.72
|
| Rate for Payer: Aetna Medicare |
$270.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.75
|
| Rate for Payer: BCBS Complete |
$186.75
|
| Rate for Payer: BCBS MAPPO |
$260.24
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: BCN Commercial |
$612.80
|
| Rate for Payer: BCN Medicare Advantage |
$260.24
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cofinity Commercial |
$348.72
|
| Rate for Payer: Cofinity Commercial |
$374.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.25
|
| Rate for Payer: Meridian Medicaid |
$186.75
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: PACE SWMI |
$260.24
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: PHP Medicare Advantage |
$260.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.34
|
| Rate for Payer: Priority Health Medicare |
$260.24
|
| Rate for Payer: Priority Health Narrow Network |
$421.34
|
| Rate for Payer: Priority Health SBD |
$421.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$260.24
|
| Rate for Payer: UHCCP Medicaid |
$177.86
|
| Rate for Payer: UMR Bronson Commercial |
$381.34
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$534.11 |
| Rate for Payer: Aetna Commercial |
$306.30
|
| Rate for Payer: Aetna Medicare |
$237.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS MAPPO |
$228.58
|
| Rate for Payer: BCBS Trust/PPO |
$534.11
|
| Rate for Payer: BCN Commercial |
$499.92
|
| Rate for Payer: BCN Medicare Advantage |
$228.58
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Cofinity Commercial |
$329.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.01
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Nomi Health Commercial |
$274.30
|
| Rate for Payer: PACE SWMI |
$228.58
|
| Rate for Payer: PHP Commercial |
$320.01
|
| Rate for Payer: PHP Medicare Advantage |
$228.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.31
|
| Rate for Payer: Priority Health Medicare |
$228.58
|
| Rate for Payer: Priority Health Narrow Network |
$437.31
|
| Rate for Payer: Priority Health SBD |
$437.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.58
|
| Rate for Payer: UHC Medicare Advantage |
$228.58
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
| Rate for Payer: UMR Bronson Commercial |
$272.78
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Aetna Medicare |
$258.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.29
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: BCBS MAPPO |
$248.81
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$248.81
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cofinity Commercial |
$333.41
|
| Rate for Payer: Cofinity Commercial |
$358.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.25
|
| Rate for Payer: Meridian Medicaid |
$179.14
|
| Rate for Payer: Nomi Health Commercial |
$298.57
|
| Rate for Payer: PACE SWMI |
$248.81
|
| Rate for Payer: PHP Commercial |
$348.33
|
| Rate for Payer: PHP Medicare Advantage |
$248.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.30
|
| Rate for Payer: Priority Health Medicare |
$248.81
|
| Rate for Payer: Priority Health Narrow Network |
$474.30
|
| Rate for Payer: Priority Health SBD |
$474.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.81
|
| Rate for Payer: UHC Medicare Advantage |
$248.81
|
| Rate for Payer: UHCCP Medicaid |
$170.61
|
| Rate for Payer: UMR Bronson Commercial |
$348.22
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$1,117.41 |
| Rate for Payer: Aetna Commercial |
$788.94
|
| Rate for Payer: Aetna Medicare |
$612.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.81
|
| Rate for Payer: BCBS Complete |
$419.35
|
| Rate for Payer: BCBS MAPPO |
$588.76
|
| Rate for Payer: BCBS Trust/PPO |
$515.09
|
| Rate for Payer: BCN Commercial |
$911.87
|
| Rate for Payer: BCN Medicare Advantage |
$588.76
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$788.94
|
| Rate for Payer: Cofinity Commercial |
$847.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.20
|
| Rate for Payer: Meridian Medicaid |
$419.35
|
| Rate for Payer: Nomi Health Commercial |
$706.51
|
| Rate for Payer: PACE SWMI |
$588.76
|
| Rate for Payer: PHP Commercial |
$824.26
|
| Rate for Payer: PHP Medicare Advantage |
$588.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.41
|
| Rate for Payer: Priority Health Medicare |
$588.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.41
|
| Rate for Payer: Priority Health SBD |
$1,117.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.76
|
| Rate for Payer: UHC Medicare Advantage |
$588.76
|
| Rate for Payer: UHCCP Medicaid |
$399.38
|
| Rate for Payer: UMR Bronson Commercial |
$531.30
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$633.33 |
| Rate for Payer: Aetna Commercial |
$369.12
|
| Rate for Payer: Aetna Medicare |
$286.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.66
|
| Rate for Payer: BCBS Complete |
$197.94
|
| Rate for Payer: BCBS MAPPO |
$275.46
|
| Rate for Payer: BCBS Trust/PPO |
$529.88
|
| Rate for Payer: BCN Commercial |
$633.33
|
| Rate for Payer: BCN Medicare Advantage |
$275.46
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Cofinity Commercial |
$396.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.23
|
| Rate for Payer: Meridian Medicaid |
$197.94
|
| Rate for Payer: Nomi Health Commercial |
$330.55
|
| Rate for Payer: PACE SWMI |
$275.46
|
| Rate for Payer: PHP Commercial |
$385.64
|
| Rate for Payer: PHP Medicare Advantage |
$275.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$517.85
|
| Rate for Payer: Priority Health Medicare |
$275.46
|
| Rate for Payer: Priority Health Narrow Network |
$517.85
|
| Rate for Payer: Priority Health SBD |
$517.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.46
|
| Rate for Payer: UHC Medicare Advantage |
$275.46
|
| Rate for Payer: UHCCP Medicaid |
$188.51
|
| Rate for Payer: UMR Bronson Commercial |
$327.06
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$339.70 |
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Medicare |
$119.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.81
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS MAPPO |
$114.45
|
| Rate for Payer: BCBS Trust/PPO |
$339.70
|
| Rate for Payer: BCN Commercial |
$324.97
|
| Rate for Payer: BCN Medicare Advantage |
$114.45
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$153.36
|
| Rate for Payer: Cofinity Commercial |
$164.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.17
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Nomi Health Commercial |
$137.34
|
| Rate for Payer: PACE SWMI |
$114.45
|
| Rate for Payer: PHP Commercial |
$160.23
|
| Rate for Payer: PHP Medicare Advantage |
$114.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.96
|
| Rate for Payer: Priority Health Medicare |
$114.45
|
| Rate for Payer: Priority Health Narrow Network |
$218.96
|
| Rate for Payer: Priority Health SBD |
$218.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.45
|
| Rate for Payer: UHC Medicare Advantage |
$114.45
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
